Coblation® Intracapsular Tonsillectomy (Tonsillotomy) in Children: A Prospective Study of 500 Consecutive Cases with Long Term Follow Up

Abstract

Objectives

Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with little published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation^® intracapsular tonsillectomy, for both obstructive and infective indications.

Design

Prospective case series, March 2013-January 2016, all with completed follow up.

Setting

Tertiary paediatric otolaryngological practice.

Participants

500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation^® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT).

Main outcome measures

Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and post-operatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure.

Results

With a mean follow up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 post-operatively, p<0.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%), otherwise no complications, delayed discharges or readmissions occurred. 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery.

Conclusions

Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

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